Symptom profiles of coronary artery bypass surgery patients at risk for poor functioning outcomes.
Symptom profiles of coronary artery bypass surgery patients at risk for poor functioning outcomes.
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冠状动脉搭桥手术患者的症状特征存在功能不良的风险。
DOI：
10.1097/jcn.0b013e3181cfba00
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Abbott,AmyA
中科院分区：
文献类型：
--
作者：
Zimmerman,Lani;Barnason,Susan;Young,Lufei;Tu,Chunhao;Schulz,Paula;Abbott,AmyA
这项二次分析的目的是对226名参与随机对照试验的患者进行冠状动脉搭桥手术后症状的分析或聚类，并检查临床医生如何使用这些分析来确定手术后前6个月内功能受损的风险组。测量的变量是症状的存在和负担和功能。基于模型的聚类方法用于聚类分析的症状负担措施，协方差分析用于确定是否有差异的功能（身体功能和体力活动）的症状负担组在6周和3个月和6个月后解雇。226例受试者中大多数已婚（86%），男性（83%），平均年龄为71岁（SD，4.96）。在基于模型的聚类方法中使用了8种症状呼吸急促、疲劳、抑郁、睡眠障碍、疼痛、肿胀、焦虑和食欲问题，并证明有3个患者症状负担集群。聚类1对所有8种症状具有低症状负担，聚类3对所有8种症状具有中等症状负担，聚类2具有低（呼吸短促、疲劳、抑郁、疼痛和焦虑）和中等症状负担（睡眠问题、肿胀和食欲问题）的组合。协方差分析显示，任何变量均无显著的聚类×时间相互作用。主效应有显著性差异（P<. 01)对于身体功能（身体和活力功能）和身体活动（估计的能量消耗和平均每日总活动计数）的症状负担组。时间的显著主效应表明，身体功能和身体活动措施，除了身体疼痛，随着时间的推移而改善（P<. 05）。研究结果表明，在出院前对冠状动脉搭桥手术患者的症状进行分析可能有助于医疗保健提供者识别在手术后的前6个月内可能存在身体功能和身体活动困难的患者。
The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. The majority of the 226 subjects were married (86%), male (83%), and had a mean age of 71 (SD, 4.96) years. Eight symptoms were used in the model-based clustering method-shortness of breath, fatigue, depression, sleep disturbances, pain, swelling, anxiety, and appetite problems-and demonstrated that there were 3 patient clusters of symptom burden. Cluster 1 had low symptom burden on all 8 symptoms, cluster 3 had moderate symptom burden on all 8 symptoms, and cluster 2 had a combination of low (shortness of breath, fatigue, depression, pain, and anxiety) and moderate symptom burden (sleep problems, swelling, and appetite problems). Analyses of covariance revealed no significant cluster× time interactions for any of the variables. However, there were significant main effects (P<. 01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P<. 05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.